Generic Interface System

Generic Interface System (GIS) Version 3.01 Based on HL7 Standard Version 2.4 Mapping Document HL7 Segments to IHS Files July 2001

TABLE OF CONTENTS Cross Reference: HL7 Segments to IHS Files Contents 1.0 DG1 DIAGNOSIS (2.4)... 1 2.0 ERR ERROR (2.4)... 3 3.0 EVN - EVENT TYPE (2.4)... 4 4.0 GT1 GUARANTOR INFORMATION (2.4)... 5 5.0 IN1 INSURANCE (2.4)... 8 6.0 IN2 - INSURANCE ADDITIONAL INFORMATION (2.4)... 12 7.0 MFA - MASTER FILE ACKNOWLEDGMENT (2.4)... 15 8.0 MFE - MASTER FILE ENTRY (2.4)... 16 9.0 MFI - MASTER FILE IDENTIFICATION (2.4)... 17 10.0 MSA - MESSAGE ACKNOWLEDGMENT (2.4)... 18 11.0 MSH - MESSAGE HEADER (2.4)... 19 12.0 NK1 - NEXT OF KIN / ASSOCIATED PARTIES (2.4)... 20 13.0 NTE - NOTES AND COMMENTS (2.4)... 24 14.0 OBR - OBSERVATION REQUEST (2.4) V MEASUREMENT (9000010.01)... 25 15.0 OBR - OBSERVATION REQUEST (2.4) V EYE GLASS (9000010.04)... 28 16.0 OBR - OBSERVATION REQUEST (2.4) V LAB (9000010.09)... 31 17.0 OBR - OBSERVATION REQUEST (2.4) V SKIN TEST (9000010.12)... 34 18.0 OBR - OBSERVATION REQUEST (2.4) V EXAM FILE (9000010.13)... 37 19.0 OBR - OBSERVATION REQUEST (2.4) V TREATMENT (9000010.15)... 40 20.0 OBR - OBSERVATION REQUEST (2.4) V PATIENT ED (9000010.16)... 43 21.0 OBR - OBSERVATION REQUEST (2.4) V PHYSICAL THERAPY (9000010.17)... 46 22.0 OBR - OBSERVATION REQUEST (2.4) V CPT (9000010.18)... 49 23.0 OBR - OBSERVATION REQUEST (2.4) V DIAGNOSTIC PROCEDURE (9000010.21)... 52 IHS Generic HL7 Message Generator/Filer V 2.0 i July 2001

24.0 OBR - OBSERVATION REQUEST (2.4) V RADIOLOGY (9000010.22)... 55 25.0 OBR - OBSERVATION REQUEST (2.4) V HEALTH FACTORS (9000010.23)... ERROR! BOOKMARK NOT DEFINED. 26.0 OBX - OBSERVATION / RESULT (2.4) V MEASUREMENT (9000010.01)... 61 27.0 OBX - OBSERVATION / RESULT (2.4) V EYE GLASS (9000010.04)... 63 28.0 OBX - OBSERVATION / RESULT (2.4) V LAB (9000010.09)... 67 29.0 OBX - OBSERVATION / RESULT (2.4) V SKIN TEST (9000010.12)... 69 30.0 OBX - OBSERVATION / RESULT (2.4) V EXAM (9000010.13)... 71 31.0 OBX - OBSERVATION / RESULT (2.4) V TREATMENT (9000010.15)... 73 32.0 OBX - OBSERVATION / RESULT (2.4) V PATIENT ED (9000010.16)... 75 33.0 OBX - OBSERVATION / RESULT (2.4) V PHYSICAL THERAPY (9000010.17)... 77 34.0 OBX - OBSERVATION / RESULT (2.4) V CPT (9000010.18)... 79 35.0 OBX - OBSERVATION / RESULT (2.4) V DIAGNOSTIC PROCEDURE (9000010.21)... 81 36.0 OBX - OBSERVATION / RESULT (2.4) V RADIOLOGY (9000010.22)... 83 37.0 OBX - OBSERVATION / RESULT (2.4) V HEALTH FACTORS (9000010.23)... 85 38.0 ORC - COMMON ORDER (2.4)... 87 39.0 PD1 - PATIENT DEMOGRAPHIC (2.4)... 89 40.0 PID - PATIENT IDENTIFICATION (2.4)... 90 41.0 PR1 PROCEDURES (2.4)... 92 42.0 PV1 - PATIENT VISIT (2.4)... 94 43.0 QAK QUERY ACKNOWLEDGEMENT (QAK) (2.4)... 98 44.0 QRD QUERY DEFINITION (2.4)... 99 45.0 QRF QUERY FILTER (2.4)... 100 46.0 RXA - PHARMACY / TREATMENT ADMINISTRATION (2.4)... 101 47.0 RXD - PHARMACY / TREATMENT DISPENSE (2.4)... 103 48.0 RXR PHARMACY/TREATMENT ROUTE (2.4)... 105 49.0 ZDX - IHS DIAGNOSIS EXTENSION (2.4)... 106 IHS Generic HL7 Message Generator/Filer V 2.0 ii July 2001

50.0 ZFD IHS DRUG FILE UPDATE (2.4)... 107 51.0 ZP1 - IHS PATIENT INFORMATION: HEALTH RECORD IDENTIFIERS (2.4) (OBSOLETE, NOW IN PID-3)... 108 52.0 ZP2 - IHS PATIENT INFORMATION (2.4)... 109 53.0 ZP3 - IHS PATIENT INFORMATION: OTHER TRIBES (2.4)...111 54.0 ZP4 - IHS PATIENT INFORMATION: PREVIOUS COMMUNITY (2.4)... 112 55.0 ZPR - IHS PROCEDURE EXTENSION (2.4)... 113 56.0 ZRA - IHS PHARMACY / TREATMENT ADMINISTRATION EXTENSION (2.4)... 114 57.0 ZV1 - IHS PATIENT VISIT (2.4)... 115 IHS Generic HL7 Message Generator/Filer V 2.0 iii July 2001

1.0 0B0BDG1 Diagnosis (2.4) The DG1 segment contains patient diagnosis information of various types, for example, admitting, primary, etc. The DG1 segment is used to send multiple diagnoses (for example, for medical records encoding). In the IHS implementation, each DG1 is followed by one ZDX. DG1 attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 1 4 SI R 00375 Set ID - Diagnosis sequential in each message from 1 to n 2 2 ID R 0053 00376 Diagnosis Coding Method 3 250 CE O 0051 00377 Diagnosis Code Patient: 9000001, 1114 [underlying cause of death] V Hosp.: 9000010.02,.12 [admitting dx] V CHS: 9000010.03,.09 [newborn dx] V POV: 9000010.07,.01 [pov] ptr to ICD Diagnosis: 80,.01 [code number] and 3 [diagnosis] ptr to ICD Diagnosis: 80,.01 [code number] and 3 [diagnosis] ptr to ICD Diagnosis: 80,.01 [code number] and 3 [diagnosis] ptr to ICD Diagnosis: 80,.01 [code number] and 3 [diagnosis] (this field works with diagnosis type field below, DG1:6) 4 40 ST B 00378 Diagnosis Description 5 26 TS O 00379 Diagnosis Date/Time 6 2 IS R 0052 00380 Diagnosis Type site-defined table... see notes in next column. (Table 0052 - user defined) 7 250 CE B 0118 00381 Major Diagnostic Category for patient, 9000001, 1114 (Underlying cause of death) use with a type code DH. for admitting, use with type code AD for newborn, use with type code NB (also, PV1:36, Newborn Baby Indicator must be Y ) for Purpose of Visit, use with code PV for other dx types, use appropriate dx type (to be specified in sitedefined table associated with this field) IHS Generic HL7 Message Generator/Filer V 2.0 1 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 8 250 CE B 0055 00382 Diagnostic Related Group 9 1 ID B 0136 00383 DRG Approval Indicator 10 2 IS B 0056 00384 DRG Grouper Review Code 11 250 CE B 0083 00385 Outlier Type 12 3 NM B 00386 Outlier Days 13 12 CP B 00387 Outlier Cost 14 4 ST B 00388 Grouper Version And Type 15 2 ID O 0359 00389 Diagnosis Priority V POV: 9000010.07,.12 Use IHS set (code only P or S) [primary/secondary] 16 250 XCN O Y 00390 Diagnosing Clinician 17 3 IS O 0228 00766 Diagnosis Classification 18 1 ID O 0136 00767 Confidential Indicator 19 26 TS O 00768 Attestation Date/Time IHS Generic HL7 Message Generator/Filer V 2.0 2 July 2001

2.0 1B1BERR Error (2.4) The ERR segment is used to add error comments to acknowledgment messages. ERR attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File IHS Notes Reference 1 80 CM R Y 00024 Error Code and Location may be used for additional information: site-defined IHS Generic HL7 Message Generator/Filer V 2.0 3 July 2001

3.0 2B2BEVN - Event Type (2.4) The EVN segment is used to communicate necessary trigger event information to receiving applications. Valid event types for all messages are contained in HL7 Table 0003 - Event Type Code. EVN attributes LEN DT R/O RP/# TBL ITEM# ELEMENT NAME IHS File IHS Notes SEQ # Reference 1 3 ID B 0003 00099 Event Type Code HL7 Event Type Code: 779.001,.01 [code] - See Note 2. IHS-supported events listed elsewhere 2 26 TS R 00100 Date/Time of Event See Notes 3 & 4, below 3 26 TS O 00101 Date/Time Planned Event 4 3 IS O 0062 00102 Event Reason Code 5 250 XCN O Y 0188 00103 Operator ID 6 26 TS O 01278 Event Occurred 7 180 HD O 01534 Event Facility Notes: 1. EVN segment is somewhat redundant, but it is required for ADT events (except for the response to the A19 - ADT record-oriented query). 2. EVN:1, event type code is a duplicate of MSH:9,2, trigger event... but use since this a required field. 3. EVN:2, event date/time is a duplicate of the transaction date (MSH:7) -- but since this is a required field, use the transaction date on update, A08, & merge events, (not needed for query return, A19, since this segment is optional for that event ) 4. EVN:2: Visit start date (aka visit admit date/time, PV1:44), visit end date (aka visit discharge/checkout date/time, PV1:45), date/time of last update for patient file (ZP1:8), and date/time of last reg update for patient file (ZP1:2) would not be used for this field since we re not using admit (A01), or discharge (A03) events, and the HL7 update event (A08) doesn t distinguish between a patient demographic or a patient reg update. IHS Generic HL7 Message Generator/Filer V 2.0 4 July 2001

4.0 3B3BGT1 Guarantor Information (2.4) The GT1 segment contains guarantor (e.g., the person or the organization with financial responsibility for payment of a patient account) data for patient and insurance billing applications. It contains the Policy holder information from RPMS. GT1 attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File IHS Notes Reference 1 4 SI R 00405 Set ID GT1 2 250 CX O Y 00406 Guarantor Number 9000003.1,.04 [Policy Number] 3 250 XPN R Y 00407 Guarantor Name 9000003.1,.01 [Name of Insured] 4 250 XPN O Y 00408 Guarantor Spouse Name 5 250 XAD O Y 00409 Guarantor Address 9000003.1,.11,.12,.13, [Address] 6 250 XTN O Y 00410 Guarantor Ph Num 9000003.1,14 [Phone Number] Home 7 250 XTN O Y 00411 Guarantor Ph Num Business 8 26 TS O 00412 Guarantor Date/Time of 9000003.1,.19 [Date of Birth] Birth 9 1 IS O 0001 00413 Guarantor Sex 9000003.1,.08 [Sex] 10 2 IS O 0068 00414 Guarantor Type 11 250 CE O 0063 00415 Guarantor Relationship 12 11 ST O 00416 Guarantor SSN 13 8 DT O 00417 Guarantor Date Begin 9000003.1,.17 [Effective Date] 14 8 DT O 00418 Guarantor Date End 9000003.1,.18 [Expiration Date] 15 2 NM O 00419 Guarantor Priority 16 250 XPN O Y 00420 Guarantor Employer 9999999.75,.01 [Employer] Name 17 250 XAD O Y 00421 Guarantor Employer Address 9999999.75,.02,.03,.04,.05 [Street Address, City, State, Zip] 18 250 XTN O Y 00422 Guarantor Employee 9999999.75,.06 [Phone Number] Phone Number 19 20 CX O Y 00423 Guarantor Employee ID Number 20 2 IS O 0066 00424 Guarantor Employment Status 9000003.1,.15 [Holders Employment Status] 21 250 XON O Y 00425 Guarantor Organization Name 22 1 ID O 0136 00773 Guarantor Billing Hold Flag IHS Generic HL7 Message Generator/Filer V 2.0 5 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File IHS Notes Reference 23 250 CE O 00774 Guarantor Credit Rating Code 24 26 TS O 00775 Guarantor Death Date and Time 25 1 ID O 0136 00776 Guarantor Death Flag 26 250 CE O 0218 00777 Guarnator Charge Adjustment Code 27 10 CP O 00778 Guarantor Household Income 28 3 NM O 00779 Guarator Household Size 29 250 CX O Y 00780 Guarantor Employer ID Number 30 250 CE O 0002 00781 Guarantor Marital Status Code 31 8 DT O 00782 Guarantor Hire Effective Date 32 8 DT O 00783 Employment Stop Date 33 2 IS O 0223 00755 Living Dependency 34 2 IS O 0009 00145 Ambulatory Status 35 250 CE O 0171 00129 Citizenship 36 250 CE O 0296 00118 Primary Language 37 2 IS O 0220 00742 Living Arrangement 38 250 CE O 0215 00743 Publicity Indicator 39 1 ID O 0136 00744 Protection Indicator 40 2 IS O 0231 00745 Student Indicator 41 250 IS O 0006 00120 Religion 42 250 XPN O 00746 Mother s Maiden Name 43 250 CE O 0212 00739 Nationality 44 250 CE O 0189 00125 Ethnic Group 45 250 XPN O Y 00748 Contact Person Name 46 250 XTN O Y 00749 Contact Person s Telephone Number 47 250 CE O 0222 00747 Contact Reason 48 2 IS O 0063 00784 Contact Relationship 49 20 ST O 00785 Job Title 50 20 JCC O 00786 Job Code/Class 51 250 XON O Y 01232 Guarantor Employer s Organization Name 52 2 IS O 0310 00753 Handicap 53 2 IS O 0311 00752 Job Status Cross Reference: HL7 Segments to IHS Files IHS Generic HL7 Message Generator/Filer V 2.0 6 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File IHS Notes Reference 54 50 FC O 0064 01231 Guarantor Financial Class 55 250 CE O Y 0005 01292 Guarantor Race IHS Generic HL7 Message Generator/Filer V 2.0 7 July 2001

5.0 4B4BIN1 Insurance (2.4) The IN1 segment contains insurance policy coverage information necessary to produce properly pro-rated and patient and insurance bills. For IHS purposes, there are three types of insurance: Medicare, Medicaid, and private-party. The IHS File References and IHS Notes columns will reflect this by the use of MCR, MCD, and PVT, respectively. IN1 attributes SEQ LEN DT R/O RP/# TBL ITEM # ELEMENT NAME IHS File Reference IHS Notes # 1 4 SI R 00426 Set ID - IN1 numeric index; 1 to n 2 250 CE R 0072 00368 Insurance Plan Id 3 250 CX R Y 00428 Insurance Company ID 4 250 XON O Y 00429 Insurance Company Name PVT: Policy Holder: 9000003.1,.03 [insurance company] 5 250 XAD O Y 00430 Insurance Company Address 6 250 XPN O Y 00431 Insurance Co. Contact Person 7 250 XTN O Y 00432 Insurance Co. Phone Number 8 12 ST O 00433 Group Number MCR: Medicare Eligible: 9000003,.04 [suffix] MCD: Medicaid Eligible: 9000004.11,.04 [state] PVT: Policy Holder: 9000003.1,.06 [group name] MCR: MEDICARE MCD: MEDICAID PVT: ptr to Insurer: 9999999.18,.01 [name] 9 250 XON O Y 00434 Group Name 10 250 CX O Y 00435 Insured s Group Emp. ID 11 250 XON O Y 00436 Insured s Group Emp Name MCR: ptr to Medicare Suffix: 9999999.32,.01 [code] PVT: ptr to Employer Group Insurance: 9999999.77,.02 [group number] IHS Generic HL7 Message Generator/Filer V 2.0 8 July 2001

SEQ LEN DT R/O RP/# TBL ITEM # ELEMENT NAME IHS File Reference IHS Notes # 12 8 DT O 00437 Plan Effective Date MCR: Medicare Eligible: 9000003.11,.01 [elig.date] MCD: Medicaid Eligible: 9000004.11,.01 [elig. date] PVT: Policy Holder: 9000003.1,.17 [effective date] 13 8 DT O 00438 Plan Expiration Date MCR: Medicare Eligible: 9000003.11,.02 [elig. end date] MCD: Medicaid Eligible: 9000004.11,.02 [elig. end date] PVT: Policy Holder: 9000003.1,.18 [expiration date] 14 250 CM O 00439 Authorization Information 15 3 IS O 0086 00440 Plan Type 16 250 XPN O Y 00441 Name Of Insured MCR: Medicare Eligible: 9000003,.05 [name of insured] MCD: Medicaid Eligible: 9000004, 2101 [medicaid name] PVT: Policy Holder: 9000003.1,.01 [name of policy holder] 17 250 CE O 0063 00442 Insured s Relationship to Patient MCR: SF MCD: SF PVT: Need to identify relationship of patient to insured, then take inverse of 18 26 TS O 00443 Insured s Date of Birth PVT: Policy Holder: 9000003.1,.19 [date of birth] that. MCR: MCD: IHS Generic HL7 Message Generator/Filer V 2.0 9 July 2001

SEQ LEN DT R/O RP/# TBL ITEM # ELEMENT NAME IHS File Reference IHS Notes # 19 250 XAD O Y 00444 Insured s Address PVT: Policy Holder: 9000003.1 MCR: MCD:.09 [holder s address - street].11 [holder s address - city].12 [holder s address - state].13 [holder s address - zip] 20 2 IS O 0135 00445 Assignment Of Benefits 21 2 IS O Y 0173 00446 Coordination Of Benefits 22 2 ST O 00447 Coord Of Ben. Priority 23 2 ID O 0136 00448 Notice Of Admission Flag 24 8 DT O 00449 Notice Of Admission Date 25 1 ID O 0136 00450 Report Of Eligibility Flag 26 8 DT O 00451 Report Of Eligibility Date 27 2 IS O 0093 00452 Release Information Code 28 15 ST O 00453 Pre-Admit Cert (PAC) 29 26 TS O 00454 Verification Date/Time 30 250 XCN O Y 00455 Verification By 31 2 IS O 0098 00456 Type Of Agreement Code 32 2 IS O 0022 00457 Billing Status 33 4 NM O 00458 Lifetime Reserve Days 34 4 NM O 00459 Delay Before L.R. Day 35 8 IS O 0042 00460 Company Plan Code 36 15 ST O 00461 Policy Number 37 12 CP O 00462 Policy Deductible 38 12 CP O 00463 Policy Limit - Amount 39 4 NM O 00464 Policy Limit - Days 40 12 CP B 00465 Room Rate - Semi- Private 41 12 CP B 00466 Room Rate - Private IHS Generic HL7 Message Generator/Filer V 2.0 10 July 2001

SEQ LEN DT R/O RP/# TBL ITEM # ELEMENT NAME IHS File Reference IHS Notes # 42 250 CE O 0066 00467 Insured s Employment Status 43 1 IS O 0001 00468 Insured s Sex MCD: Medicaid Eligible: MCR: 9000004,.07 [sex of insured] PVT: Policy Holder: 9000003.1,.08 [policy holder s sex] 44 250 XAD O Y 00469 Insured s Employer Address 45 2 ST O 0076 00470 Verification Status 46 8 IS O 0072 00471 Prior Insurance Plan ID 47 3 IS O 0309 01227 Coverage Type MCR: Medicare Eligible: 9000003.11,.03 [coverage type] MCD: Medicaid Eligible: 9000004.11,.03 [coverage type] PVT: Policy Holder: 9000003.1,.05 [coverage type] 48 2 IS O 0310 00753 Handicap 49 250 CX O Y 01230 Insured s ID Number MCR: Medicare Eligible: 9000003,.03 [medicare number] MCD: Medicaid Eligible: 9000004,.03 [medicaid number] PVT: Policy Holder: 9000003.1,.04 [policy number] PVT: ptr to Coverage Type: 9999999.65,.01 [name] (See IHS TABLE INSURANCE COVERAGE TYPE) IHS Generic HL7 Message Generator/Filer V 2.0 11 July 2001

6.0 5B5BIN2 - Insurance Additional Information (2.4) The IN2 segment contains additional insurance policy coverage and benefit information necessary for proper billing and reimbursement. Fields used by this segment are defined by HCFA or other regulatory agencies. IN2 attributes SEQ LEN DT R/O RP/# TBL# ITEM ELEMENT NAME IHS File Reference IHS Notes # 1 250 CX O Y 00472 Insured s Employee ID 2 11 ST O 00473 Insured s Social Security Number 3 250 XCN O Y 00474 Insured s Employer Name Policy Holder: 9000003.1,.16 [employer] -> Employer: 9999999.18,.01 [name] 4 1 IS O 0139 00475 Employer Information Data 5 1 IS O Y 0137 00476 Mail Claim Party 6 15 ST O 00477 Medicare Health Ins Card Number Medicare Eligible: 9000003,.03 [medicare number] 7 250 XPN O Y 00478 Medicaid Case Name 8 15 ST O 00479 Medicaid Case Number Medicaid Eligible: 9000004,.13 [case number] 9 250 XPN O Y 00480 Champus Sponsor Name 10 20 ST O 00481 Champus ID Number 11 250 CE O 0342 00482 Dependent of Champus Recipient 12 25 ST O 00483 Champus Organization 13 25 ST O 00484 Champus Station 14 14 IS O 0140 00485 Champus Service 15 2 IS O 0141 00486 Champus Rank/Grade 16 3 IS O 0142 00487 Champus Status 17 8 DT O 00488 Champus Retire Date 18 1 ID O 0136 00489 Champus Non-Avail Cert On File 19 1 ID O 0136 00490 Baby Coverage 20 1 ID O 0136 00491 Combine Baby Bill 21 1 ST O 00492 Blood Deductible 22 250 XPN O Y 00493 Special Coverage Approval Name 23 30 ST O 00494 Special Coverage Approval Title IHS Generic HL7 Message Generator/Filer V 2.0 12 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM ELEMENT NAME IHS File Reference IHS Notes # 24 8 IS O Y 0143 00495 Non-Covered Insurance Code 25 250 CX O Y 00496 Payor ID 26 250 CX O Y 00497 Payor Subscriber ID 27 1 IS O 0144 00498 Eligibility Source 28 250 CM O Y 0145/0146 00499 Room Coverage Type/Amount 29 250 CM O Y 0147/0193 00500 Policy Type/Amount 30 250 CM O 00501 Daily Deductible 31 2 IS O 0223 00755 Living Dependence 32 2 IS O 0009 00145 Ambulatory Status 33 250 CE O 0171 00129 Citizenship 34 250 CE O 0296 00118 Primary Language 35 2 IS O 0220 00742 Living Arrangement 36 250 CE O 0215 00743 Publicity Indicator 37 1 ID O 0136 00744 Protection Indicator 38 2 IS O 0231 00745 Student Indicator 39 250 IS O 0006 00120 Religion 40 250 XPN O Y 00746 Mother s Maiden Name 41 250 CE O 0212 00739 Nationality 42 250 CE O Y 0189 00125 Ethnic Group 43 250 CE O Y 0002 00119 Marital Status 44 8 DT O 00787 Insured s Employment Start Date 45 8 DT O 00783 Insured s Employment Stop Date 46 20 ST O 00785 Job Title 47 20 JCC O 0327/0328 00786 Job Code/Class 48 2 IS O 0311 00752 Job Status 49 250 XPN O Y 00789 Employer Contact Person Name 50 250 XTN O Y 00790 Employer Contact Person Phone Number 51 2 IS O 0222 00791 Employer Contact Reason 52 250 XPN O Y 00792 Insured s Contact Person s Name 53 250 XTN O Y 00793 Insured s Contact Person Telephone Number 54 2 IS O Y 0222 00794 Insured s Contact Person Reason IHS Generic HL7 Message Generator/Filer V 2.0 13 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM ELEMENT NAME IHS File Reference IHS Notes # 55 8 DT O 00795 Relationship To The Patient Start Date 56 8 DT O Y 00796 Relationship To The Patient Stop Date 57 2 IS O 0232 00797 Insurance Co. Contact Reason 58 250 XTN O 00798 Insurance Co Contact Phone Number 59 2 IS O 0312 00799 Policy Scope 60 2 IS O 0313 00800 Policy Source 61 250 CX O 00801 Patient Member Number 62 250 CE O 0063 00802 Guarantor s Relationship To Insured 63 250 XTN O Y 00803 Insured s Telephone Number - Home 64 250 XTN O Y 00804 Insured s Employer Telephone Number 65 250 CE O 0343 00805 Military Handicapped Program 66 1 ID O 0136 00806 Suspend Flag 67 1 ID O 0136 00807 Copay Limit Flag 68 1 ID O 0136 00808 Stoploss Limit Flag 69 250 XON O Y 00809 Insured Organization Name And ID 70 250 XON O Y 00810 Insured Employer Organization Name And ID 71 250 CE O Y 0005 00113 Race 72 250 CE O 0344 00811 HCFA Patient Relationship To Insured IHS Generic HL7 Message Generator/Filer V 2.0 14 July 2001

7.0 6B6BMFA - Master File Acknowledgment (2.4) MFA attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 1 3 ID R 0180 00664 Record-Level Event Code 2 20 ST C 00665 MFN Control ID 3 26 TS O 00668 Event Completion Date/Time 4 250 CE R 0181 00669 Error Return Code And/Or Text 5 250 CE R Y 9999 01308 Primary Key Value MFA 6 3 ID R Y 0355 01320 Primary Key Value Type MFA IHS Generic HL7 Message Generator/Filer V 2.0 15 July 2001

8.0 7B7BMFE - Master File Entry (2.4) MFE attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 1 3 ID R 0180 00664 Record-Level Event Code 2 20 ST C 00665 MFN Control ID 3 26 TS O 00662 Effective Date/Time 4 200 Varie R Y 00667 Primary Key Value - MFE s 5 3 ID R Y 0355 01319 Primary Key Value Type MFE IHS Generic HL7 Message Generator/Filer V 2.0 16 July 2001

9.0 8B8BMFI - Master File Identification (2.4) MFI attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 1 250 CE R 0175 00658 Master File Identifier 2 180 HD O 00659 Master File Application Identifier 3 3 ID R 0178 00660 File-Level Event Code 4 26 TS O 00661 Entered Date/Time 5 26 TS O 00662 Effective Date/Time 6 2 ID R 0179 00663 Response Level Code IHS Generic HL7 Message Generator/Filer V 2.0 17 July 2001

10.0 9B9BMSA - Message Acknowledgment (2.4) The MSA segment contains information sent while acknowledging another message. MSA attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File Reference IHS Notes 1 2 ID R 0008 00018 Acknowledgment Code HL7 Acknowledgement Code - for accept acks 2 20 ST R 00010 Message Control ID echoed back from initial message 3 80 ST O 00020 Text Message may be used for additional information: site-defined 4 15 NM O 00021 Expected Sequence if using HL7 sequence # protocol Number 5 1 ID O 0102 00022 Delayed acknowledgment Type 6 250 CE O 0357 00023 Error Condition may be used for additional information: site-defined IHS Generic HL7 Message Generator/Filer V 2.0 18 July 2001

11.0 10B10BMSH - Message Header (2.4) The MSH segment defines the intent, source, destination, and some specifics of the syntax of a message. MSH attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File IHS Notes Reference 1 1 ST R 00001 Field Separator 2 4 ST R 00002 Encoding Characters ^~\& 3 180 HD O 0361 00003 Sending Application 4 180 HD O 0362 00004 Sending Facility 5 180 HD O 0361 00005 Receiving Application 6 180 HD O 0362 00006 Receiving Facility 7 26 TS O 00007 Date/Time Of Message transaction date/time 8 40 ST O 00008 Security 9 13 CM R 0076/0003 00009 Message Type HL7 Message Type HL7 Event Type Code 10 20 ST R 00010 Message Control ID unique ID for message, echoed back in MSA segment 11 3 PT R 00011 Processing ID usually P 12 60 VID R 0104 00012 Version ID HL7 Version 2.4 13 15 NM O 00013 Sequence Number If using on a broadcast link 14 180 ST O 00014 Continuation Pointer if need to continue message 15 2 ID O 0155 00015 Accept acknowledgment Type HL7 Accept / Application ACK Condition AL 16 2 ID O 0155 00016 Application acknowledgment Type 17 2 ID O 0399 00017 Country Code Country Code - 18 16 ID O Y 0211 00692 Character Set 19 250 CE O 00693 Principal Language Of Message 20 20 ID O 0356 01317 Alternate Character Set Handling Scheme 21 10 ID O Y 0449 01598 Conformance Statement ID IHS Generic HL7 Message Generator/Filer V 2.0 19 July 2001

12.0 1B1BNK1 - Next of Kin / Associated Parties (2.4) The NK1 segment contains information about the patient s other related parties. Any associated parties may be identified. Utilizing the NK1:1 (Set ID) field, multiple NK1 segments can be sent to patient accounts. In the IHS implementation, this segment has a potential of four (4) different uses, based on the values in NK1:3 (Relationship) and NK1:7 (Contact Role). Numbers in the IHS File Reference and IHS Notes columns indicate for which option the field is valued. 1. NK1:3 = self, NK1:7 = : This NK1 will carry the patient s employment status and the patient s employer s name. No other sequence numbers will be used. 2. NK1:3 = spouse, NK1:7 = : This NK1 will carry the patient s spouse s employer s name. No other sequence numbers will be used. 3. NK1:3 = any valid value, NK1:7 = NOK : This NK1 identifies the patient s next-of-kin. NK1:3 identifies the NOK s relationship to the patient (brother, sister, etc), with name, address, and phone number information included in the segment. 4. NK1:3 = any valid value, NK1:7 = EC : This NK1 identifies the patient s emergency contact. NK1:3 identifies the EC s relationship to the patient (brother, sister, etc), with name, address, and phone number information included in the segment. NK1 attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 1 4 SI R 00190 Set ID - Next of Kin / required field, but not really needed: Associated Parties use integer sequence number for # 2 250 XPN Y 00191 Name 3) VA Patient: 2,.211 [next of kin] 4) VA Patient: 2,.331 [emergency contact] NK1 s in the message. 3) name for NOK 4) name for EC IHS Generic HL7 Message Generator/Filer V 2.0 20 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 3 250 CE 0063 00192 Relationship 3) VA Patient: 2,.212 [nok relationship] 4) VA Patient: 2,.332 [ec relationship] used alone to identify self and spouse employer NK1s; used in conjunction with NK1:7 to provide twolevel identification of NOK and EC relationships 1) self (xref: Relationship: 9999999.36,.01) 2) spouse ( ) 3) ptr to Relationship: 9999999.36,.01 [name] 4) ptr to Relationship: 9999999.36,.01 4 250 XAD Y 00193 Address 3) VA Patient: 2,.213,.214,.215 [nok address-street].216 [nok addresscity].217 [nok addressstate].218 [nok addresszip] 4) VA Patient: 2,.333,.334,.335 [ec address-street].336 [ec addresscity].337 [ec addressstate].338 [ec addresszip] [name] 3) next-of-kin address 4) emergency contact address 5 250 XTN Y 00194 Phone Number 3) VA Patient: 2,.219 [nok phone] 4) VA Patient: 2,.339 [ec phone] 6 250 XTN Y 00195 Business Phone Number 7 250 CE 0131 00196 Contact Role Relationship: 9999999.36,.01 [name] - used in conjunction with NK1:3 to provide two-level identification of NOK and EC relationships (See IHS TABLE RELATIONSHIP) 3) NOK 4) EC 8 8 DT 00197 Start Date IHS Generic HL7 Message Generator/Filer V 2.0 21 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 9 8 DT 00198 End Date 10 60 ST 00199 Next of Kin Job Title 11 20 JCC 0327/ 00200 Next of Kin Job 0328 Code/Class 12 250 CX 00201 Next of Kin Employee Number 13 250 XON Y 00202 Organization Name 1) Patient: 9000001,.19 [employer name] 2) Patient: 9000001,.22 [spouse s employer name] 14 250 CE 0002 Marital Status 15 1 IS 0001 Sex 16 26 TS Date of Birth 17 2 ID Y 0223 Living Dependency 18 2 ID Y 0009 Ambulatory Status 19 250 CE Y 0171 Citizenship 20 250 CE 0296 Primary Language 21 2 IS 0220 Living Arrangement 22 250 CE 0215 Publicity Code 23 1 ID 0136 Protection Indicator 24 2 ID 0231 Student Indicator 25 250 ID 0006 Religion 26 250 XPN Y Mother s Maiden Name 27 250 CE 0212 Nationality 28 250 ID Y 0189 Ethnic Group 29 250 CE Y 0222 Contact Reason 30 250 XPN Y Contact Person s Name 31 250 XTN Y Contact Person s Telephone Number 32 250 XAD Y Contact Person s Address 33 250 CX Y Associated Party s Identifiers 34 2 IS 0311 Job Status Code 1) Patient: 9000001,.21 [employment status] 35 250 CE Y 0005 Race 36 2 IS 0295 Handicap Code Cross Reference: HL7 Segments to IHS Files 1) name for patient s employer (relationship = self ) - ptr to Employer: 9999999.75,.01 [employer] 2) name for spouse s employer (relationship = spouse ) - ptr to Employer: 9999999.75,.01 [employer] IHS set: use code and translation (relationship = self ). IHS Generic HL7 Message Generator/Filer V 2.0 22 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 37 16 ST Contact Person Social Security Number * Non-standard datatype and length for this field Cross Reference: HL7 Segments to IHS Files IHS Generic HL7 Message Generator/Filer V 2.0 23 July 2001

13.0 12B12BNTE - Notes and Comments (2.4) The NTE segment is a common format for sending notes and comments. NTE attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File Reference IHS Notes 1 4 SI O 00096 Set ID - Notes and Comments 2 8 ID O 0105 00097 Source of Comment 3 64k FT O Y 00098 Comment 4 250 CE O 0364 01318 Comment Type IHS Generic HL7 Message Generator/Filer V 2.0 24 July 2001

IHS Cross Reference: HL7 Segments to IHS Files 14.0 13B13BOBR - Observation Request (2.4) V Measurement (9000010.01) The OBR (Observation Request) segment is used to transmit information specific to an order for a diagnostic study or observation, physical exam, or assessment. It defines the attributes of a particular request for diagnostic services (e.g., laboratory, EKG) or clinical observations, vital signs or physical exam. OBR attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME0F0F File IHS Notes Reference 1 4 SI O 00237 Set ID - Observation Request 2 22 EI C 00216 Placer Order Number 3 22 EI C 00217 Filler Order Number + This is generated by concatenating the V File IEN^Visit Date^MSR, See IHS TABLE FILLER ORDER NUMBER IDENTIFIER) 4 250 CE R 00238 Universal Service ID See Notes This is generated by concatenating the 9000010.01^V MEASUREMENT^99IHS^Measureme nt Type^Code 5 2 ID X 00239 Priority 6 26 TS X 00240 Requested Date/time 7 26 TS C 00241 Observation Date/Time # See Notes The IHS visit date/time 8 26 TS O 00242 Observation End Date/Time # 9 20 CQ O 00243 Collection Volume * 10 250 XCN O Y 00244 Collector Identifier * 11 1 ID O 0065 00245 Specimen Action Code * 12 250 CE O 00246 Danger Code 13 300 ST C 00247 Relevant Clinical Info. 14 26 TS C 00248 Specimen Received Date/Time * 15 300 CM O 0070 00249 Specimen Source * 16 250 XCN O Y 00226 Ordering Provider See Notes 17 250 XTN O Y/2 00250 Order Callback Phone Number 18 60 ST O 00251 Placer field 1 19 60 ST O 00252 Placer field 2 20 60 ST O 00253 Filler Field 1 + 21 60 ST O 00254 Filler Field 2 + IHS Generic HL7 Message Generator/Filer V 2.0 25 July 2001

IHS Cross Reference: HL7 Segments to IHS Files SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME0F0F File IHS Notes Reference 22 26 TS C 00255 Results Rpt/Status Chng Should be valued for a corrected report. - Date/Time + 23 40 CM O 00256 Charge to Practice + 24 10 ID C 0074 00257 Diagnostic Serv Sect ID 25 1 ID C 0123 00258 Result Status + Assumed to be= F for final, or C for corrected (see OBR:22) 26 400 CM O 00259 Parent Result + 27 200 TQ O Y 00221 Quantity/Timing 28 250 XCN O Y/5 00260 Result Copies To 29 200 CM O 00261 Parent Number + 30 20 ID O 0124 00262 Transportation Mode 31 250 CE O Y 00263 Reason for Study 32 200 CM O 00264 Principal Result Interpreter + 33 200 CM O Y 00265 Assistant Result Interpreter + 34 200 CM O Y 00266 Technician + 35 200 CM O Y 00267 Transcriptionist + 36 26 TS O 00268 Scheduled Date/Time + 37 4 NM O 01028 Number of Sample Containers * 38 250 CE O Y 01029 Transport Logistics of Collected Sample * 39 250 CE O Y 01030 Collector's Comment * 40 250 CE O 01031 Transport Arrangement Responsibility 41 30 ID O 0224 01032 Transport Arranged 42 1 ID O 0225 01033 Escort Required 43 250 CE O Y 01034 Planned Patient Transport Comment 44 250 CE O Y 0088 00393 Procedure Code 45 250 CE O Y 0340 01316 Procedure Code Modifier 46 250 CE O Y 0411 01474 Placer Supplemental Service Information 47 250 CE O Y 0411 01475 Filler Supplemental Service Information IHS Generic HL7 Message Generator/Filer V 2.0 26 July 2001

Notes for Element Name Column: Cross Reference: HL7 Segments to IHS Files The daggered (+) items in this segment are not created by the placer. They are created by the filler and valued as needed when the OBR segment is returned as part of a report. Hence on a new order sent to the filler, they are not valued. There is an exception when the filler initiates the order. In that case, the filler order number is valued and the placer order number may be blank. The starred (*) fields are only relevant when an observation is associated with a specimen. These are completed by the placer when the placer obtains the specimen. They are completed by the filler when the filler obtains the specimen. OBR-7-observation date/time and OBR-8-observation end date/time (flagged with #) are the physiologically relevant times. In the case of an observation on a specimen, they represent the start and end of the specimen collector. In the case of an observation obtained directly from a subject (e.g., BP, Chest X-ray), they represent the start and end time of the observation. 9000010.01, V Measurement File. Used for vital signs. OBR:4 = 9000010.01,.01 [type] -> Measurement Type: 9999999.07,.01 [type] and.02 [description] (See chapter 7, Appendix A, AS4- Physical exam codes- vital signs and similar extensions) OBR:7 = 9000010.01,.03 [visit] -> Visit:9000010,.01 [visit / admit date & time] IHS Generic HL7 Message Generator/Filer V 2.0 27 July 2001

15.0 14B14BOBR - Observation Request (2.4) V Eye Glass (9000010.04) The OBR (Observation Request) segment is used to transmit information specific to an order for a diagnostic study or observation, physical exam, or assessment. It defines the attributes of a particular request for diagnostic services (e.g., laboratory, EKG) or clinical observations, vital signs or physical exam. OBR attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME1F1 IHS File IHS Notes Reference 1 4 SI O 00237 Set ID - Observation Request 2 22 EI C 00216 Placer Order Number 3 22 EI C 00217 Filler Order Number + This is generated by concatenating the V File IEN^Visit Date^EYE, See IHS TABLE FILLER ORDER NUMBER IDENTIFIER) 4 250 CE R 00238 Universal Service ID See Notes This is generated by concatenating the 9000010.04^V EYE GLASS^99IHS 5 2 ID X 00239 Priority 6 26 TS X 00240 Requested Date/time 7 26 TS C 00241 Observation Date/Time # See Notes The IHS visit date/time 8 26 TS O 00242 Observation End Date/Time # 9 20 CQ O 00243 Collection Volume * 10 250 XCN O Y 00244 Collector Identifier * 11 1 ID O 0065 00245 Specimen Action Code * 12 250 CE O 00246 Danger Code 13 300 ST C 00247 Relevant Clinical Info. 14 26 TS C 00248 Specimen Received Date/Time * 15 300 CM O 0070 00249 Specimen Source * 16 250 XCN O Y 00226 Ordering Provider See Notes 17 250 XTN O Y/2 00250 Order Callback Phone Number 18 60 ST O 00251 Placer field 1 19 60 ST O 00252 Placer field 2 20 60 ST O 00253 Filler Field 1 + 21 60 ST O 00254 Filler Field 2 + 22 26 TS C 00255 Results Rpt/Status Chng Should be valued for a corrected report. - Date/Time + 23 40 CM O 00256 Charge to Practice + IHS Generic HL7 Message Generator/Filer V 2.0 28 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME1F1 IHS File IHS Notes Reference 24 10 ID C 0074 00257 Diagnostic Serv Sect ID 25 1 ID C 0123 00258 Result Status + Assumed to be= F for final, or C for corrected (see OBR:22) 26 400 CM O 00259 Parent Result + 27 200 TQ O Y 00221 Quantity/Timing 28 250 XCN O Y/5 00260 Result Copies To 29 200 CM O 00261 Parent Number + 30 20 ID O 0124 00262 Transportation Mode 31 250 CE O Y 00263 Reason for Study 32 200 CM O 00264 Principal Result Interpreter + 33 200 CM O Y 00265 Assistant Result Interpreter + 34 200 CM O Y 00266 Technician + 35 200 CM O Y 00267 Transcriptionist + 36 26 TS O 00268 Scheduled Date/Time + 37 4 NM O 01028 Number of Sample Containers * 38 250 CE O Y 01029 Transport Logistics of Collected Sample * 39 250 CE O Y 01030 Collector's Comment * 40 250 CE O 01031 Transport Arrangement Responsibility 41 30 ID O 0224 01032 Transport Arranged 42 1 ID O 0225 01033 Escort Required 43 250 CE O Y 01034 Planned Patient Transport Comment 44 250 CE O Y 0088 00393 Procedure Code 45 250 CE O Y 0340 01316 Procedure Code Modifier 46 250 CE O Y 0411 01474 Placer Supplemental Service Information 47 250 CE O Y 0411 01475 Filler Supplemental Service Information Notes for Element Name Column: The daggered (+) items in this segment are not created by the placer. They are created by the filler and valued as needed when the OBR segment is returned as part of a report. Hence on a new order sent to the filler, they are not valued. There is an exception when the filler initiates the order. In that case, the filler order number is valued and the placer order number may be blank. IHS Generic HL7 Message Generator/Filer V 2.0 29 July 2001

The starred (*) fields are only relevant when an observation is associated with a specimen. These are completed by the placer when the placer obtains the specimen. They are completed by the filler when the filler obtains the specimen. OBR-7-observation date/time and OBR-8-observation end date/time (flagged with #) are the physiologically relevant times. In the case of an observation on a specimen, they represent the start and end of the specimen collector. In the case of an observation obtained directly from a subject (e.g., BP, Chest X-ray), they represent the start and end time of the observation. 9000010.04, V Eye Glass File. Used for eyeglass prescription data. OBR:4 = 9000010.04,.01 [name] Create/locate appropriate code [file note: this entry will always be 1 ] OBR:7 = 9000010.04,.03 [visit] -> Visit:9000010,.01 [visit / admit date & time] IHS Generic HL7 Message Generator/Filer V 2.0 30 July 2001

IHS Cross Reference: HL7 Segments to IHS Files 16.0 15B15BOBR - Observation Request (2.4) V Lab (9000010.09) The OBR (Observation Request) segment is used to transmit information specific to an order for a diagnostic study or observation, physical exam, or assessment. It defines the attributes of a particular request for diagnostic services (e.g., laboratory, EKG) or clinical observations, vital signs or physical exam. OBR attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME2F2F File IHS Notes Reference 1 4 SI O 00237 Set ID - Observation Request 2 22 EI C 00216 Placer Order Number This is the accession number 3 22 EI C 00217 Filler Order Number + This is generated by concatenating the V File IEN^Visit Date^LAB, See IHS TABLE FILLER ORDER NUMBER IDENTIFIER) 4 250 CE R 00238 Universal Service ID See Notes This is generated by concatenating the 9000010.09^V LAB^99IHS^Lab Test^ LAB 5 2 ID X 00239 Priority 6 26 TS X 00240 Requested Date/time 7 26 TS C 00241 Observation Date/Time # See Notes The IHS lab collection date/time 8 26 TS O 00242 Observation End Date/Time # 9 20 CQ O 00243 Collection Volume * 10 250 XCN O Y 00244 Collector Identifier * 11 1 ID O 0065 00245 Specimen Action Code * 12 250 CE O 00246 Danger Code 13 300 ST C 00247 Relevant Clinical Info. 14 26 TS C 00248 Specimen Received Date/Time * 15 300 CM O 0070 00249 Specimen Source * 16 250 XCN O Y 00226 Ordering Provider See Notes 17 250 XTN O Y/2 00250 Order Callback Phone Number 18 60 ST O 00251 Placer field 1 19 60 ST O 00252 Placer field 2 20 60 ST O 00253 Filler Field 1 + 21 60 ST O 00254 Filler Field 2 + 22 26 TS C 00255 Results Rpt/Status Chng Should be valued for a corrected report. - Date/Time + IHS Generic HL7 Message Generator/Filer V 2.0 31 July 2001

IHS Cross Reference: HL7 Segments to IHS Files SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME2F2F File IHS Notes Reference 23 40 CM O 00256 Charge to Practice + 24 10 ID C 0074 00257 Diagnostic Serv Sect ID 25 1 ID C 0123 00258 Result Status + Assumed to be= F for final, or C for corrected (see OBR:22) 26 400 CM O 00259 Parent Result + 27 200 TQ O Y 00221 Quantity/Timing 28 250 XCN O Y/5 00260 Result Copies To 29 200 CM O 00261 Parent Number + 30 20 ID O 0124 00262 Transportation Mode 31 250 CE O Y 00263 Reason for Study 32 200 CM O 00264 Principal Result Interpreter + 33 200 CM O Y 00265 Assistant Result Interpreter + 34 200 CM O Y 00266 Technician + 35 200 CM O Y 00267 Transcriptionist + 36 26 TS O 00268 Scheduled Date/Time + 37 4 NM O 01028 Number of Sample Containers * 38 250 CE O Y 01029 Transport Logistics of Collected Sample * 39 250 CE O Y 01030 Collector's Comment * 40 250 CE O 01031 Transport Arrangement Responsibility 41 30 ID O 0224 01032 Transport Arranged 42 1 ID O 0225 01033 Escort Required 43 250 CE O Y 01034 Planned Patient Transport Comment 44 250 CE O Y 0088 00393 Procedure Code 45 250 CE O Y 0340 01316 Procedure Code Modifier 46 250 CE O Y 0411 01474 Placer Supplemental Service Information 47 250 CE O Y 0411 01475 Filler Supplemental Service Information Notes for Element Name Column: The daggered (+) items in this segment are not created by the placer. They are created by the filler and valued as needed when the OBR segment is returned as part of a report. Hence on a new order sent to the filler, they are not valued. There is an exception when the filler initiates the order. In that case, the filler order number is valued and the placer order number may be blank. IHS Generic HL7 Message Generator/Filer V 2.0 32 July 2001

The starred (*) fields are only relevant when an observation is associated with a specimen. These are completed by the placer when the placer obtains the specimen. They are completed by the filler when the filler obtains the specimen. OBR-7-observation date/time and OBR-8-observation end date/time (flagged with #) are the physiologically relevant times. In the case of an observation on a specimen, they represent the start and end of the specimen collector. In the case of an observation obtained directly from a subject (e.g., BP, Chest X-ray), they represent the start and end time of the observation. 9000010.09, V Lab File. OBR:2 = 9000010.09, 1102 [order] Construct a valid placer number by concatenating with the visit date, and the universal service identifier to create a unique long term identifier that can serve as the placer number. OBR:4 = 9000010.09,.01 [lab test] -> Laboratory Test: 60. For the first triplet of CE, use 60, 14 -> Procedure Field: 61.5, 2 [snomed code] and.01 [name], with SNM as the code authority; for the second triplet of CE, use 60,.01 [name] and 99IHS as the code authority OBR:8 = 9000010.09, 1201 [collection date and time] OBR:15 = 9000010.09, 1103 [site] -> Topography Field: 61,.01 [name] - Translate into standard HL7 table for specimen source (see section 4.5.1.15) OBR:16 = 9000010.09, 1202 [ordering provider] -> Provider:6,5 [DEA #] and.01 [name] -> Person: 16,.01 [name] IHS Generic HL7 Message Generator/Filer V 2.0 33 July 2001

17.0 16B16BOBR - Observation Request (2.4) V Skin Test (9000010.12) The OBR (Observation Request) segment is used to transmit information specific to an order for a diagnostic study or observation, physical exam, or assessment. It defines the attributes of a particular request for diagnostic services (e.g., laboratory, EKG) or clinical observations, vital signs or physical exam. OBR attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME3F3 IHS File IHS Notes Reference 1 4 SI O 00237 Set ID - Observation Request 2 22 EI C 00216 Placer Order Number 3 22 EI C 00217 Filler Order Number + This is generated by concatenating the V File IEN^Visit Date^SK, See IHS TABLE FILLER ORDER NUMBER IDENTIFIER) 4 250 CE R 00238 Universal Service ID See Notes This is generated by concatenating the 9000010.12^V SKIN TEST^99IHS^Skin Test Type^Code 5 2 ID X 00239 Priority 6 26 TS X 00240 Requested Date/time 7 26 TS C 00241 Observation Date/Time # See Notes The IHS visit date/time 8 26 TS O 00242 Observation End Date/Time # 9 20 CQ O 00243 Collection Volume * 10 250 XCN O Y 00244 Collector Identifier * 11 1 ID O 0065 00245 Specimen Action Code * 12 250 CE O 00246 Danger Code 13 300 ST C 00247 Relevant Clinical Info. 14 26 TS C 00248 Specimen Received Date/Time * 15 300 CM O 0070 00249 Specimen Source * 16 250 XCN O Y 00226 Ordering Provider See Notes 17 250 XTN O Y/2 00250 Order Callback Phone Number 18 60 ST O 00251 Placer field 1 19 60 ST O 00252 Placer field 2 20 60 ST O 00253 Filler Field 1 + 21 60 ST O 00254 Filler Field 2 + 22 26 TS C 00255 Results Rpt/Status Chng - Date/Time + Should be valued for a corrected report. IHS Generic HL7 Message Generator/Filer V 2.0 34 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME3F3 IHS File IHS Notes Reference 23 40 CM O 00256 Charge to Practice + 24 10 ID C 0074 00257 Diagnostic Serv Sect ID 25 1 ID C 0123 00258 Result Status + Assumed to be= F for final, or C for corrected (see OBR:22) 26 400 CM O 00259 Parent Result + 27 200 TQ O Y 00221 Quantity/Timing 28 250 XCN O Y/5 00260 Result Copies To 29 200 CM O 00261 Parent Number + 30 20 ID O 0124 00262 Transportation Mode 31 250 CE O Y 00263 Reason for Study 32 200 CM O 00264 Principal Result Interpreter + 33 200 CM O Y 00265 Assistant Result Interpreter + 34 200 CM O Y 00266 Technician + 35 200 CM O Y 00267 Transcriptionist + 36 26 TS O 00268 Scheduled Date/Time + 37 4 NM O 01028 Number of Sample Containers * 38 250 CE O Y 01029 Transport Logistics of Collected Sample * 39 250 CE O Y 01030 Collector's Comment * 40 250 CE O 01031 Transport Arrangement Responsibility 41 30 ID O 0224 01032 Transport Arranged 42 1 ID O 0225 01033 Escort Required 43 250 CE O Y 01034 Planned Patient Transport Comment 44 250 CE O Y 0088 00393 Procedure Code 45 250 CE O Y 0340 01316 Procedure Code Modifier 46 250 CE O Y 0411 01474 Placer Supplemental Service Information 47 250 CE O Y 0411 01475 Filler Supplemental Service Information Notes for Element Name Column: The daggered (+) items in this segment are not created by the placer. They are created by the filler and valued as needed when the OBR segment is returned as part of a report. Hence on a new order sent to the filler, they are not valued. There is an exception when the filler initiates the order. In that case, the filler order number is valued and the placer order number may be blank. IHS Generic HL7 Message Generator/Filer V 2.0 35 July 2001

The starred (*) fields are only relevant when an observation is associated with a specimen. These are completed by the placer when the placer obtains the specimen. They are completed by the filler when the filler obtains the specimen. OBR-7-observation date/time and OBR-8-observation end date/time (flagged with #) are the physiologically relevant times. In the case of an observation on a specimen, they represent the start and end of the specimen collector. In the case of an observation obtained directly from a subject (e.g., BP, Chest X-ray), they represent the start and end time of the observation. 9000010.12, V Skin Test File. Used for Skin test such as TB. OBR:4 = 9000010.12,.01 [skin test] -> Skin Test: 9999999.28,.02 [code] and.01 [name] OBR:7 = 9000010.12, 1201 [event date and time] (when skin test was given ) OBR:8 = 9000010.12,.06 [date read] (when skin test was read ) IHS Generic HL7 Message Generator/Filer V 2.0 36 July 2001

IHS Cross Reference: HL7 Segments to IHS Files 18.0 17B17BOBR - Observation Request (2.4) V Exam File (9000010.13) The OBR (Observation Request) segment is used to transmit information specific to an order for a diagnostic study or observation, physical exam, or assessment. It defines the attributes of a particular request for diagnostic services (e.g., laboratory, EKG) or clinical observations, vital signs or physical exam. OBR attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME4F4F File IHS Notes Reference 1 4 SI O 00237 Set ID - Observation Request 2 22 EI C 00216 Placer Order Number 3 22 EI C 00217 Filler Order Number + This is generated by concatenating the V File IEN^Visit Date^XAM, See IHS TABLE FILLER ORDER NUMBER IDENTIFIER) 4 250 CE R 00238 Universal Service ID See Notes This is generated by concatenating the 9000010.13^V EXAM^99IHS^Exam Type^Code 5 2 ID X 00239 Priority 6 26 TS X 00240 Requested Date/time 7 26 TS C 00241 Observation Date/Time # See Notes The IHS visit date/time 8 26 TS O 00242 Observation End Date/Time # 9 20 CQ O 00243 Collection Volume * 10 250 XCN O Y 00244 Collector Identifier * 11 1 ID O 0065 00245 Specimen Action Code * 12 250 CE O 00246 Danger Code 13 300 ST C 00247 Relevant Clinical Info. 14 26 TS C 00248 Specimen Received Date/Time * 15 300 CM O 0070 00249 Specimen Source * 16 250 XCN O Y 00226 Ordering Provider See Notes 17 250 XTN O Y/2 00250 Order Callback Phone Number 18 60 ST O 00251 Placer field 1 19 60 ST O 00252 Placer field 2 20 60 ST O 00253 Filler Field 1 + 21 60 ST O 00254 Filler Field 2 + 22 26 TS C 00255 Results Rpt/Status Chng Should be valued for a corrected report. - Date/Time + IHS Generic HL7 Message Generator/Filer V 2.0 37 July 2001

IHS Cross Reference: HL7 Segments to IHS Files SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME4F4F File IHS Notes Reference 23 40 CM O 00256 Charge to Practice + 24 10 ID C 0074 00257 Diagnostic Serv Sect ID 25 1 ID C 0123 00258 Result Status + Assumed to be= F for final, or C for corrected (see OBR:22) 26 400 CM O 00259 Parent Result + 27 200 TQ O Y 00221 Quantity/Timing 28 250 XCN O Y/5 00260 Result Copies To 29 200 CM O 00261 Parent Number + 30 20 ID O 0124 00262 Transportation Mode 31 250 CE O Y 00263 Reason for Study 32 200 CM O 00264 Principal Result Interpreter + 33 200 CM O Y 00265 Assistant Result Interpreter + 34 200 CM O Y 00266 Technician + 35 200 CM O Y 00267 Transcriptionist + 36 26 TS O 00268 Scheduled Date/Time + 37 4 NM O 01028 Number of Sample Containers * 38 250 CE O Y 01029 Transport Logistics of Collected Sample * 39 250 CE O Y 01030 Collector's Comment * 40 250 CE O 01031 Transport Arrangement Responsibility 41 30 ID O 0224 01032 Transport Arranged 42 1 ID O 0225 01033 Escort Required 43 250 CE O Y 01034 Planned Patient Transport Comment 44 250 CE O Y 0088 00393 Procedure Code 45 250 CE O Y 0340 01316 Procedure Code Modifier 46 250 CE O Y 0411 01474 Placer Supplemental Service Information 47 250 CE O Y 0411 01475 Filler Supplemental Service Information Notes for Element Name Column: The daggered (+) items in this segment are not created by the placer. They are created by the filler and valued as needed when the OBR segment is returned as part of a report. Hence on a new order sent to the filler, they are not valued. There is an exception when the filler initiates the order. In that case, the filler order number is valued and the placer order number may be blank. IHS Generic HL7 Message Generator/Filer V 2.0 38 July 2001